Heydari Fatemeh, Karimpour-Razkenari Elahe, Azadtarigheh Parnian, Vahdatinia Alireza, Salahshoor Ali, Alipour Abbas, Moosazadeh Mahmood, Gholipour Baradari Afshin, Monajati Mahila, Naderi-Behdani Fahimeh
Department of Anesthesiology and Critical Care Medicine, Imam Khomeini Hospital.
Department of Clinical Pharmacy, Faculty of Pharmacy.
Ann Med Surg (Lond). 2023 Nov 20;86(1):42-49. doi: 10.1097/MS9.0000000000001379. eCollection 2024 Jan.
COVID-19, the most destructive pandemic of this century, caused the highest mortality rate among ICU patients. The evaluation of these patients is insufficient in lower-middle-income countries with limited resources during pandemics. As a result, our primary goal was to examine the characteristics of patients at baseline as well as their survival outcomes, and propose mortality predictors for identifying and managing the most vulnerable patients more effectively and quickly.
A prospective analysis of COVID-19 ICU-admitted patients was conducted in our healthcare centre in Iran, from 1 April until 20 May 2020. Ninety-three patients were included in the study, and all were unvaccinated. A multi-variate logistic regression was conducted to evaluate mortality-associated factors.
There were 53 non-survivors among our ICU-admitted patients. The mean duration from symptoms' onset to hospitalization was 6.92 ± 4.27 days, and from hospitalization to ICU admission was 2.52 ± 3.61 days. The average hospital stay for patients was 13.23 ± 10.43 days, with 8.84 ± 7.53 days in the ICU. Non-survivors were significantly older, had significantly lower haemoglobin levels and higher creatine phosphokinase levels compared to survivors. They had marginally lower SpO2 levels at admission, higher vasopressor administrations, and were intubated more significantly during their ICU stay. The use of immunosuppressive drugs was also significantly higher in non-survivors. Logistic regression revealed that a one-point increase in APACHE II score at ICU admission increased mortality by 6%, and the presence of underlying diseases increased mortality by 4.27 times.
The authors presented clinical mortality prediction factors for critically ill patients infected with COVID-19. Additional studies are necessary to identify more generalized mortality indicators for these patients in lower-middle-income countries.
2019冠状病毒病（COVID-19）是本世纪最具破坏性的大流行病，导致重症监护病房（ICU）患者死亡率最高。在大流行期间，资源有限的中低收入国家对这些患者的评估不足。因此，我们的主要目标是研究患者基线特征及其生存结果，并提出死亡率预测指标，以便更有效、快速地识别和管理最脆弱的患者。
2020年4月1日至5月20日，在伊朗我们的医疗中心对入住ICU的COVID-19患者进行了前瞻性分析。93名患者纳入研究，均未接种疫苗。进行多因素逻辑回归以评估与死亡相关的因素。
我们入住ICU的患者中有53例死亡。从症状出现到住院的平均时长为6.92±4.27天，从住院到入住ICU的平均时长为2.52±3.61天。患者的平均住院时间为13.23±10.43天，在ICU的时间为8.84±7.53天。与幸存者相比，非幸存者年龄显著更大，血红蛋白水平显著更低，肌酸磷酸激酶水平更高。他们入院时的血氧饱和度（SpO2）水平略低，血管活性药物使用更多，在ICU住院期间插管比例更高。非幸存者使用免疫抑制药物的比例也显著更高。逻辑回归显示，入住ICU时急性生理与慢性健康状况评分系统（APACHE II）评分每增加1分，死亡率增加6%，存在基础疾病使死亡率增加4.27倍。
作者提出了COVID-19感染重症患者的临床死亡预测因素。有必要开展更多研究，以确定中低收入国家这些患者更具普遍性的死亡指标。
